Economic Impact of Diabetes and High-Deductible Health Plans

By Danélia Botes

April 2, 2024


Diabetes, a chronic health condition, is a significant contributor to global healthcare costs. It can lead to severe complications such as cardiovascular disease, blindness, and end-stage kidney disease. The financial burden of managing diabetes is immense, with patients incurring over a quarter of all health care costs in the US. This article examines the economic aspects of diabetes management and the role of high-deductible health plans (HDHPs).

The Rising Costs of Diabetes Management:

The costs associated with diabetes management are staggering. In the US, individuals with diabetes spend approximately $12,000 more on healthcare compared to those without the disease. The financial burden is heavily influenced by the patient’s health insurance.

Additional Financial Factors and Comorbid Diseases:

Previous studies have revealed that the financial strain of managing diabetes is not just limited to the direct cost of treatment. It extends to the indirect costs associated with increased financial burden, less frequent ambulatory care, and delayed care for cardiovascular conditions. Furthermore, the complications of diabetes are not just restricted to hyperglycemia, hypertension, and dyslipidemia. There are other comorbidities such as cardiovascular disease, blindness, and end-stage kidney disease that significantly add to the overall cost of managing this chronic condition. Hence, the economic impact of diabetes is a multifaceted issue that extends beyond the immediate costs of medication and treatment.

The Role of High-Deductible Health Plans:

HDHPs, defined as plans with individual deductibles of $1400 or more and family deductibles of $2800 or more, are increasingly prevalent. By 2017, nearly 44% of individuals with employer-sponsored health plans had HDHPs. The enrolment of people with diabetes in HDHPs is only marginally lower than those without chronic conditions.

The Impact of HDHPs on Diabetes Complications:

Switching to an HDHP can increase the risks of severe complications among people with diabetes. The effect on microvascular and macrovascular complications is still unknown. However, previous studies have shown that HDHP enrolment among people with diabetes leads to increased financial burden, less frequent ambulatory care, and delayed care for cardiovascular conditions.

Findings and Specific Figures:

This recent research indicates a significant correlation between HDHP enrollment and the incidence of diabetes complications. The switch from a non-HDHP to an HDHP resulted in a notable increase in the rates of all diabetes complications. This ranged from an 11% increase in the risk of myocardial infarction to a staggering 253% increase in the risk of ESKD. Furthermore, the association between HDHP enrollment and each complication amplified with each additional year of HDHP enrollment, highlighting the cumulative impact of financial barriers in accessing care.


The study shows a clear link between enrollment in an HDHP and a higher risk of chronic diabetes complications. We saw significant increases in diabetes complications rates after a patient switched to an HDHP. If these plans covered evidence-based chronic disease care and preventive services, it could lessen the financial burden of HDHPs. These findings highlight the urgent need for a thorough review of our current health insurance models. We need to develop patient-centric approaches that reduce financial pressure on people with chronic conditions like diabetes. Therefore, while HDHPs save costs for employers and payers, they may not be the best answer to the high and rising healthcare costs in the US.

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